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An elderly woman with dyspnoea and bronchorrhoea
  1. J Poloa,
  2. P Gila,
  3. R Arboiroa,
  4. J Garcíab,
  5. P Beringolac,
  6. G Marína
  1. aFundación Jiménez Díaz, Madrid, Spain: Department of Internal Medicine, bDepartment of Pneumology, cDepartment of Radiology, CEP “Pontones”, Madrid, Spain
  1. Dr Jorge Polo, O'Donnell 56, 28007 Madrid, Spainpolosabau{at}yahoo.com

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Answers on p 347.

A 78 year old woman presented with progressively increasing dyspnoea and cough, initially dry and later with production of whitish sputum with foamy appearance, which she had had for the last three months, accompanied by anorexia and loss of 5 kg of weight. There was no history of fever, chest pain, oedema, orthopnoea, or haemoptysis. Except for arterial hypertension treated with calcium antagonists, she had never experienced any medical or surgical problem. Examination revealed tachycardia (128 beats/min) and tachypnoea. Inspiratory crackles were heard over the lower and middle fields of both lungs. The rest of the examination was normal. During her hospital admission, sputum production increased to 600 ml in one day.

Routine blood and biochemistry values were normal. Her erythrocyte sedimentation rate was 36 and 58 mm/hour after one and two hours respectively. Arterial blood gases while breathing room air revealed oxygen tension 6.67 kPa and carbon dioxide tension 3.73 kPa, with little improvement after receiving 40% oxygen (7.73 kPa and 4.61 kPa, respectively). Serum precipitins for alternaria, aspergillus, cladosporum, penicillium, candida and thermoactinomyces, as well as cytological and microbiological studies of sputum, were all negative. Levels of angiotensin converting enzyme and total IgE were normal.

A radiograph of the chest (fig 1) showed diffuse alveolar disease. Computed tomography showed a bilateral alveolar interstitial pattern with pseudonodular densities (figs 2 and3).

Figure 1

Radiograph of the chest.

Figure 2

Computed tomogram of the thorax at the level just below the carina trachealis.

Figure 3

Computed tomogram of the thorax at the level of the axilla.

Questions

(1)
What is your diagnosis?
(2)
What other disorders may show a diffuse alveolar pattern?
(3)
What are other causes of bronchorrhoea?

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